Depressants Cocaine

A meta-analysis of placebo-controlled studies by Levin and Lehman (1991) showed that desipramine produced greater cocaine abstinence than placebo. Although a more recent review did not concur (Lima et al. 2001), secondary analyses of studies with imipramine, desipramine, and bupropion suggested that depressed cocaine abusers are more likely to show significant reductions in cocaine abuse than nondepressed cocaine abusers (Margolin et al. 1995 Nunes et al. 1991 Ziedonis and Kosten 1991). Furthermore, recent work with desipramine supported its efficacy in opioid-dependent patients, particularly in combination with contingency management therapies (Kosten et al. 2004 Oliveto et al. 1999). 

Ziedonis DM and Kosten TR (1991). Pharmacotherapy improves treatment outcome in depressed cocaine addicts. Journal of Psychoactive Drugs, 23, 417-425. 

The metabolism of cocaine leaves the person with an abnormal letdown, called "crashing". In an attempt to soften this severe depression cocaine is often compounded with heroin called a "speedball". This is common among those who started out as either heroin or cocaine abusers. The comedian John Belushi died from such a mixture. 

Other nonreceptor site of action interactions include MAOIs - pethidine (acute dystonias), ethanol - benzodiazepines (synergisitic sedation and respiratory depression), cocaine - amphetamines (hypertensive crisis) and dihydrocodeine -morphine (the former is a partial agonist and reduces the efficacy of the full agonist). 

Cocaine. This lias a bitter taste, is mydriatic, produces local anaesthesia and is toxic. After absorption, or when taken internally, it acts chiefly by stimulation of the central nervous system, succeeded by depression. Since the two phases may be present in different areas simultaneously, a mixed result may ensue. With large doses the chief symptoms are those of medullary depression. Death is due to paralysis of the respiratory centre. The main use of cocaine in medicine is as a local anaesthetic. 

Antipsychotic medications are indicated in the treatment of acute and chronic psychotic disorders. These include schizophrenia, schizoaffective disorder, and manic states occurring as part of a bipolar disorder or schizoaffective disorder. The co-adminstration of antipsychotic medication with antidepressants has also been shown to increase the remission rate of severe depressive episodes that are accompanied by psychotic symptoms. Antipsychotic medications are frequently used in the management of agitation associated with delirium, dementia, and toxic effects of both prescribed medications (e.g. L-dopa used in Parkinson s disease) and illicit dtugs (e.g. cocaine, amphetamines, andPCP). They are also indicated in the management of tics that result from Gilles de la Tourette s syndrome, and widely used to control the motor and behavioural manifestations of Huntington s disease. 

Dependence and withdrawal can occur with all of the stimulants. Cocaine is one of the most strongly reinforcing drugs in self-administration paradigms in animals and also has a psychological withdrawal syndrome. A typical pattern of withdrawal includes a ravenous appetite, exhaustion, and mental depression, which may last for several days after the drug is withdrawn. Because tolerance develops quickly, abusers may take large doses, compared with those used medically, for example, as anorexiants. 

Schmitz JM, Averill P, Stotts AL, et al Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Drug Alcohol Depend 63 207-214,2001 Schottenfeld RS, Pakes JR, Oliveto A, et al Buprenorphine vs methadone maintenance treatment for concurrent opioid dependence and cocaine abuse. Arch Gen Psychiatry 54 713-720, 1997... 

Sevarino KA, Oliveto A, Kosten TR Neurobiological adaptations to psychostimulants and opiates as a basis of treatment development. Ann N Y Acad Sci 909 51 —87,2000 Silberman EK, Reus VI, Jimerson DC, et al Heterogeneity of amphetamine response in depressed patients. AmJ Psychiatry 138 1302—1307, 1981 Sofuoglu M, Brown S, Babb DA, et al Depressive symptoms modulate the subjective and physiological response to cocaine in humans. Drug Alcohol Depend 63 131-137, 2001... 

Uslaner J, Kalechstein A, Richter T, et al Association of depressive symptoms during abstinence with the subjective high produced by cocaine. Am J Psychiatry 156 1444-1446, 1999... 

Ziedonis DM, Kosten TR Depression as a prognostic factor for pharmacological treatment of cocaine dependence. Psychopharmacol Bull 27 337-343, 1991... 

Large or quickly repeating doses over a period of hours can led to extreme anxiety, paranoia and even hallucinations. These effects usually disappear as the drug is eliminated from the body. The after-effects of cocaine and crack use may include fatigue and depression as people come down from the high. Excessive doses can cause death from respiratory or heart failure but this is rare. 

The treatment goals for acute intoxication of ethanol, cocaine/amphetamines, and opioids include (1) management of psychological manifestations of intoxication, such as aggression, hostility, or psychosis, and (2) management of medical manifestations of intoxication such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, or stroke. 

Kl, a 27-year-old woman, was admitted to the cardiology unit from the emergency department after she called 911 claiming that she had severe chest pain. Upon arrival in the ED it was noted that her blood pressure was slightly elevated at 143/92 mm Hg, and that she was diaphoretic. She was in otherwise good physical condition, with no previous cardiac history. After a urine toxicology screen was positive for cocaine she admitted that she had smoked several rocks of crack an hour prior to having the chest pain. She said she almost never uses crack, but she s currently really depressed because she has lost her job. 

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